EBOLA HEMORRHAGIC FEVER – UGANDA (07): (KIBAALE)

EBOLA HEMORRHAGIC FEVER – UGANDA (07): (KIBAALE)
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The Ugandan Ministry of Health (MOH) has reported an outbreak of Ebola hemorrhagic fever in the Kibaale District of western Uganda. As of 31 Jul 2012, there have been 38 cases and 16 deaths. Five cases have been laboratory confirmed.

Ebola hemorrhagic fever (Ebola HF) is a rare and deadly disease. The disease is native to several African countries and is caused by the Ebola virus. It is spread by direct contact with blood and/or body fluids of a person infected with Ebola virus. It is also spread by contact with a contaminated object or infected animal. Symptoms include fever, headache, joint and muscle aches, sore throat, and weakness, followed by diarrhea, vomiting, and stomach pain. Skin rash, red eyes, and internal and external bleeding may be seen in some patients.

There is no vaccine for Ebola and no specific treatment. Although travelers are at low risk for the disease, it is important to take steps to prevent Ebola HF.

– Practice good hygiene. Avoid contact with blood and body fluids of infected people. Do not handle items that may have come in contact with an infected person’s blood or body fluids.

Clinician Information: Ebola is a notifiable condition in the United States. Diagnosing Ebola HF in a person who has been infected only a few days is difficult because early symptoms, such as red eyes and a skin rash, are nonspecific to the virus and are seen in patients with other diseases that occur much more frequently. However, if a person has the symptoms described above, and infection with Ebola virus is suspected, isolate the patient and notify local and state health departments and CDC.

Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing, IgM ELISA, polymerase chain reaction (PCR), and virus isolation can be used to diagnose a case of Ebola HF within a few days of the onset of symptoms. Persons tested later in the course of the disease or after recovery can be tested for IgM and IgG antibodies; the disease can also be diagnosed retrospectively in deceased patients by using immunohistochemistry testing, virus isolation, or PCR.

There is no standard treatment for Ebola HF. Patients receive supportive therapy that consists of balancing the patient’s fluids and electrolytes, maintaining their oxygen status and blood pressure, and treating them for any complicating infections.

Two more people have died in Uganda’s Ebola outbreak, officials working at a hospital said Wednesday [1 Aug 2012]. This brings the death toll to 16 people. They died in an outbreak that began in the Kibaale district in western Uganda. One of the 2 latest deaths was of a 14-year-old boy whose 9 relatives also have died in the outbreak in the district’s Nyanswiga village, where the 1st case is thought to have been. The 2 died in a hospital in Kagadi, a town close to the Congolese border. About 36 suspected cases have been reported, World Health Organization spokesman Tariq Jasarevic said Tuesday [31 Jul 2012].

The deaths have stoked heightened fear about the spread of the virus, a highly infectious, often fatal agent spread through direct contact with bodily fluids. Symptoms can include fever, vomiting, diarrhea, abdominal pain, headache, a measles-like rash, red eyes and, at times, bleeding from body openings.

Market day was canceled Wednesday [1 Aug 2012] after Uganda’s president warned people not to gather in large groups. Drivers of taxi motorbikes called boda-boda have become reluctant to take on passengers, and there have been rumours that public transportation will be banned. Health officials urged the public to report any suspected cases, to avoid contact with anyone infected, and to wear gloves and masks while disinfecting bedding and clothing of infected people. Officials also advised avoiding public gatherings in the affected district.

Teams in Uganda are taking an aggressive approach, including trying to track down anyone who came into contact with patients infected with the virus, and health workers have been gearing up for better protection of health workers and an influx of cases. The workers include people from Uganda’s Ministry of Health, the U.S. Centers for Disease Control and Prevention, and the WHO.

The outbreak initially went undetected because patients did not show typical symptoms, Ugandan Health Minister Dr. Christine Ondoa told CNN on Sunday [29 Jul 2012]. Patients had fevers and were vomiting but did not show other typical symptoms, such as haemorrhaging. Diagnosis in an individual who has only recently been infected can be difficult, since early symptoms, such as red eyes and skin rash, are seen more frequently in patients who have more common diseases, the CDC said.

Uganda’s Ministry of Health declared the outbreak in Kibaale district Saturday [28 Jul 2012] after the Uganda Virus Research Institute identified the disease as Ebola hemorrhagic fever, Sudan strain. Some people delayed seeking treatment, in part, because they believed that “evil spirits” had sickened them, according to a report from district health authorities. “This caused civil strife among the community, requiring police intervention to quell the animosity,” the Health Ministry said.

An emergency team of 100 volunteers underwent training this week to help spread the word in vulnerable communities about the disease and its transmission, the Uganda Red Cross Society said. Medecins Sans Frontieres helped set up a hospital isolation centre. The WHO did not recommend any travel or trade restrictions be applied to Uganda because of the outbreak. The U.S. Embassy in Kampala issued an emergency message for U.S. citizens that said the outbreak appeared to be centered in Nyamarunda Sub County, Kibaale district, although one suspected victim is reported to have traveled to Kampala for treatment at Mulago Hospital, where he died on 22 Jul 2012. It urged avoiding contact with dead animals, especially primates, and refraining from eating “bushmeat.”

Ebola virus was 1st detected in 1976 in the central African nation of Zaire (now the Democratic Republic of the Congo). The virus is named after a river in that country, where the 1st outbreak of the disease was found. There are 5 species of Ebola viruses, all named after the areas where they were found: Zaire, Sudan, Cote d’Ivoire, Bundibugyo and Reston, according to the WHO.

[Byline: David McKenzie]

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[The above are representative reports from current statements on the progress of the outbreak of Ebola haemorrhagic fever centred on Kibaale, Uganda.